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159 King Arthur Ln
, • t., • .,,�; DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street �(�`� �� Mocksville,NC 27028 �l\ (336)751-8760 Fax#(336)751-8786 �,\ OPERATION PERMIT Account #: 990004450 Tax PIN/EH #: 5861-48-6389 Billed To: Larry Dunn Subdivision Info: . � Reference Name: Location/Address: King Arthur Lane-27006 Proposed Facility: Residence Property Size: see map ATC Number: 3988 **NOTE**The issuance of this Operation Pemut shall indicate the system described on the ATC has been installed in compliance with Article 11 of G.S.Chapter 130A,Section.1900"Sewage Treatment and Disposal Systems," but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. System Type:�S.T.Manufacturer�Tank Date /�Z- Tank Si � Pump Tank Size System Installed By: �T�'"`�"'� ����H�.Speci ' at • � � t�cc,� � �� _ ' i,�� _ �� . : -- . 4� q �� ` � J � � �\� ` � �� ` � �' � � }-��5�� � � � � l^ -}'-'Z�T _ 4� , , DCHD 11/06(Revised) ' DAVIE COUNTY HEALTH DEPARTMENT • � ' Environmental Health Section � ��U �� ':�"��` � ' P.O.Boa 848/210 Hospital Street T � r/� �,0 Mocksville,NC 27028 �f'T-t'f�t°.�(,e(J� ` ,(336)75]-87C►0 ,:; IMPROVEMENT/OPERATION PERMTT r, . Account #: 990004450 Tax PIN/EH#: 5861-48-6389 Biiled To: Larry Dunn Subdivision Info: Reference Name: Location/Address: 159 King Arthur Lane-27006 Proposed Facility: Residence Property Size: .85 ATC Number: 3988 . - - - - ----— - - -- _ _ ___--- -------- �. ____ ------ **NOTE**This Improvement/Operation Permit DOES NOT authorize the construction of a septic tank system Qr any wastewater � system. An AiTTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building permit(in compliance with Article 1 l of G.S. Chapter 130A,Wastewater.Systems, Section .1900 Sewage Treatment and Disposal Systems). T�iIS PERNIIT IS SUBJECT TO REVOCATION IF SITE PLANS OR TI�INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type "�L`�t� #People #Bedrooms�_ #Baths � Dishwasher: � Garbage Disposal: ❑ Washing Machine: �� Basement w/Plumbing: ❑ BasementlNo Plumbing: 0 Commercial Specification: Faciliry Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size ��� �� Type Water Supply W�^��Design Wastewater Flow(GPD) �� Site: New�Repair❑ �� �� r System Specifications: Tank Size ��-�GAL. Pump Tank GAL. Trench Width� Rock Depth �Z Linear Ft. � . . . h , ocn�: 1 F`�I�T2����io� �s-�C, � , Required Site Modifications/Conditions: K� �� �f� � �l�f�.�u'�� , �-����� W4.'r-� IMPROVEMENT/OPERATION ERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6��BELOW FINISHED CRADE. ****NOTI E: Contact a representative ofthe Da �ountyHealth Dep rtment for final inspection ofthis system between 8:30 a.m.to 9:30 a. ,or 1:00 .m.�to 1:30 p.m. s�y���is�-�'.�lep one#is(336)751-87G0.**** n n �� "1O� � ,'�e.�2.� �+4�►'a������.�.._ s' Tor�� I lo �`"�'' Z—=Q.l�h� ��tin,���?(� � . �^ M�r� LO � �� ��� � �� No�!�= , ,��t,�c, �c.� �� „� Hs � ,3 F"easr � � � , � �� ���a� c� N��-1 C��GQ�'"�-'' 7�� !� • ���� , � �� � l �'�����,- Environmental Health SpecialisYs Signature: ` ate: fo L DCHD OS/99(Revised) .,ti �i � � _ ��(`�` " ��I' SITE EVALUATION/IMPROVEMENT PERMIT &ATC � 1� `�' Davie County Environmental Health ��� �� P.O.Box 848/210 Hospital Street �j E�; S�� 2 � �� Mocksville,NC 27028 , '.� �:-' _jN (33�751-8760/Fax(336)751-8786 N n�R�ZA�N�� , � Ap licati n F6'�`y��P��t� on/Improvement Permit f�'Authorization To Construct(ATC) oth Typ of Appli ' . ew System ORepair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTAN7***THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION � " Name to be Billed .L/�rri a:' V �. �Gr'�1,�/ Contact Person ij/�f'� y /Q- ,[�G�',v�✓ Billing Address_ /,��'i S� /�'�;'ni^ L.�rJ Home Phonet�//� �oy-�<y i_ G ;'a 7 City/State/ZIP__/�p�/l��i,s`//.e T �./c' �70� �' Business Phone �I/r.�iri,� Name on Permit/ATC if Different than Above , Mailing Address � City/State/Zip J/ � PROPERTY INFORMATION *Date House/Facili Corners Flagged P�usc A r�a� ,�I���e NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan �Plat(to scale) (Permit is valid for 60 months with site plan,no expiration with complete plat.) Owner's Name_�..,,¢,F' !� y �• ���,�y Phone Number 7n�/—,�L//- _,7'O� Owner'sAddress /%�"",�%IS'� /�f'j!'��,n L,,,r/ City/State/Zip1'f�'��ksv,'j,/,z �c ��p.�i�' Property Address JC�%�/�i �/'��f,.r r �>t/ City ,�iJ�%��,�� ' Lot Size e��"� Tax PIN# S^�''� /��G��� ; Subdivision Name(if applicable) /1/t��/.*� Section/Lot# Directions To Site: l�' z/�st ��-4 f,p r//�n �!' ��. �i�/�- �� ,n�'�/�`��/ �?�.�vn.�,,,� __�O �!��.�/-r-i ,�� l��il�r L/1/ L�i t.� � f � /� ]'� l �' i f ` ..v ��_ �' `i.-j• c,_-Y��i��/ F �I r 'vE' .r�, �� r. If the answer to any of the following questions is"yes",supporting documentatio}� must be attached. Are there any existing wastewater systems on the site? ❑Yes C�'N� Does the site contain jurisdictional wetlands? ❑Yes C�No Are there any easements or right-of-ways on the site? ❑Yes [�To Is the site subject to approval by another public agency? ❑Yes [�To Will wastewater other than domestic sewage be generated? ❑Yes G�To � IF RESIDENCE FILL OUT THE BOX BELOW � #People Z' #Bedrooms �' #Bathrooms %z- Garden Tub/Whirlpool ❑Yes o Basement: DYes C�o Basement Plumbing: ❑Yes C�}3Qo IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of FacilityBusiness Total Square Footage of Building #People #Sinks #Commodes #Showers #Urinals Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: #Seats Type systemrequested; l�onventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: County/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes C�YNo If yes,what type? This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any pemut(s)or ATC(s)issued hereafter are subject to suspension or revocation if the site is altered,the intended use changes,or if the information submitted in this application is falsified or changed. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and corners and locating and flagging or staking the house/facility location,proposed well location and the location of any other amenities. �J���� /� !( - ����'/� Site Revisit Charge Property owner's or owner's legal representative signature • Date(s): �-a �� `'J� Client Notification Date: Date EHS: Sign given OYes ONo Account# Revised 11/06 � Invoice# �`� � o; �. 04� j � � � � � �� �x���� � �� �� � � -� �, � - � ' � - � � �' ��'✓� t� =�� � � � S � ` '�� S., � �,�, -�- �s��Q f/ � �---� �� �S� x�.�, � ��„S"' � ti � � � � 0 Gt fl/r`/ �i`�1�,,� U� � r , . � • � . • DAVIE COUNTY HEALTH DEPARTMENT - _ . , Environmental Health Section " ' ' `. • P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-87G0 IMPROVEMENT/OPERATION PERMIT Account #: 990002706 Tax PIN/EH#: 5861-48-6550.JH Billed To: Jeff Hayes Subdivision lnfo: � Reference Name: [��Zjt� �N� �`Z7`� Location/Address: King Arthur Lane-27006 Proposed Facility Residence Property Size: see map �� /�/W����k���� ll ATC Number: 3988 **NOTE**This Improvement/Operation Permit DOES NOT authorize the construction ofa septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A,Wastewater Systems,Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. � � Residential Specification: Building Type ;^{C�C� #People #Bedrooms � #Baths Dishwasher: � Garbage Disposal: � Washing Machine: � Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size O�� �C.Q+3 Type Water Supply W�^��Design Wastewater Flow(GPD) �7 Site: New�Repair❑ �r '� , System Specifications:_ Tank Size ���GAL. Pump Tank GAL. Trench Width� Rock Depth �Z Linear Ft. � otn�: I `�1�Tfz���to,� �-�C, � , Required Site Modifications/Conditions: K� ��� �E7�� � �t��� �-��-''�`' � ��I��Q� '��— IMPROVEMENT/OPERATION ERMIT LAYOUT- APPROVED EFFLUENT FiLTER RISER(S)IF 6 f°BELOW FINISHED GRADE. ****NOTI E: Contact a representative ofthe Da ' �ounty Health Dep ent for final inspection ofthis system between 8:30 a.m.to 9:30 a. .or 1:00 p.m.�to 1:30 p.m. go ��a�la�:,�—��.lep one#is(336)751-87G0.**** ,��2'' ��Al2'vJ1ti..L. �f 3�, �1�� ToTaL ��O �,,�r �l�lQ� p��.�,�iiJC� I •� to �'T`�i +�C� �?/�� � �� M�� �th��= -� Ns' '�iMA''c. �"�� t��H- � Fp�T �� � � � �� ��,a� 70' � H�c� c��c2,�,�-�. � � ��� � � � = � Q��� Environmental Health Specialist's Signature: - ' ate: � L DCHD OS/99(Revised) ' , : � : •. . DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/Z10 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990002706 Tax PIN/EH#: 5861-48-6550.JH Billed To: Jeff Hayes Subdivision Info: Reference Name: Location/Address: King Arthur Lane-27006 Proposed Facility Residence Property Size: see map ATC Number: 3988 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** T'his Authorization for Wastewater System Construction MUST BE ISSLJED by the Davie County Environmental Health Section prior to issuance of any building petmit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s)(in compliance with Article 11 of G.S.Chaptec 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWA U I IS I FO RIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: �J CERTIFICATE OF COMPLETION **NOTE** The issuance ofthis Certificate ofCompletion shall indicate the system described on ImprovemendOperation Permit has been installed in compliance with Article 11 of G.S.Chapter 130A,Section.1900"Sewage Treatment and Disposal Systems,"but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. Septic System Installed By: Environmental Health SpecialisYs Signature: Date: DCHD OS/99(Revised) fEB. 4. 2005 -1:4]PM CBT TR1AD+ 998 4492 ND. 1358 P. 1 ' � � . . . ��y �, --- . . . . . , . / �u���ucanoc�Fou srn��t�uua-rioN/��rnoveauKc i�u«in s�aYc � • • . Davi�County Hea{th Dapartment . �iivironine�ta/flealthsectron g'1g� P.O. box 84U/oA0 Soapitul Stzcet ' l�focksville, HC 27020 . (336)951-0760 � . , +�*TFIP�I2T.WT*w*'TiiIS 1�PPLICATION C1lNNOT DTs PRO�S� �LL55 AT+L TIiL 12EQIII1tLD ...� INFOIiMATZON x5 BROVXDLD Rafor to tho XN50IIMATION IIULLETZN for inntracCi.Oun. V _ • L tiama to Do Dillcd�►�IBS� �����O°t'ct Paraon��Q\'�' �:.e'S • - � tsailin,Addre�z ,a �� c� uowc lbono• .. ..---. ... .. etcr�s�ace/zu'��d ar�es.-, t�C� o'Z�70D\v auo�eno imw�o a99-OS��..__. .—_ 1. Nasn an YctuLt/7SC if DSEtoronC than 7�60�0 � � ----•..••.. . Xailiag hddroaa � � CicP/S Co/Zip , . -- � , • . , � . ����.'_----- �. Ay8lacatioa For: �Sitc �valuation Imp wemenC PorY t/aTC CJ Uatl] . i �. �, syateu to se�vicc:�Hou�e ❑ Mol�ilc xome � nusiac99 O Iriflustry ❑ oClicr M____. . � � y . !. Type �y�eam r�Qae�a:�onvontlonal � comcatioml modilicd Q imovati�n • i. IL• Iic�idcace: A People A DefIrooms �_. i BuL-l�rooma .�:__. lariaa�her QGarbage biepoaal �aahia4+s�chiau ❑�a+rewaat!?iwibin�� OnacawoatJao riumnin� 7. 21 Duoiaeos/IndYntrr/0[her: vestly typo' T Pcoplo Q SSAk: � . { COMOdG3 11 ShowaT� IF V=iG31II I HSCCY COO1CfD____ � - IF FOOD5ERVIC�: Il Seata �stimated Water Uaage (9alloa�pex c4iy) ' a. a]mo 01 xater aurrly:�County/Ci,ty D Freii ❑ Communiey . - !. Do you anticipaee additton� or c.tpansions of llic facililr ttis syslcu�is Ldcuded lu sr.rvcT��'� t�Ku � k[��rs,�vbattppcq . . _ '••lAfl' Ti11Y'!�'�*CLi�lVTSblG07COAlPLL'T.ETi1L 'QUl/U:DYKOPL•'SYt`Y3Mt�O1th1ATl01VitGQUl:S'fL•'ll � . U£(AW. uUeraPLATorS1'I'�PLrtNAff/STBCSUIlb! L•Dbyt6cefient 1vIt6TH1SAPP(.IGI'nort. Yrapccly llimctuions: � 0 X 1 X Z..$� IYItITE D!lZliCl'lOIVS(�roni N)ut4srillc)tu 17tUPlilCl'S': . r,xorr,«rtcr: � 58(al�-�g-�.S--�QS �S� Ea-�- � �.�- ar. propertyAddtess: RoadP(aiuc �n _��-_.,�12� �0-��Q�� �oo.t� `t'o ��� , _ ciry2�p� _1a�ca.��'�c�b ci n �� I�R..�,�i R. �n.L . �,}- . . If in a SuyJivisim�providc i��inrraalion,ns faUom:. � � Namc� . . - 5cetion: Iilocic Lot: Datc ltomc corucrs Daggcd;,�`]..�4� 17�is Is to ccrtiLy thai lhc uilormaHou proridcd Is corrcet to tLc bcst of my kuotivleJgc.I uitJcrsl�uJ(6�t anp peruul(s) 7rsucd i�crcoftcr arc zaLjcct to susPwLsioq oP nroCatiott,If Wc Sitc pl�1s uYintcndCd ttso clt�gC�ar if(Gc Litonuaiiou aubmi((cJinihtsappf;caliouisL,IsiAedareL•rngc�ll,ntso,ur�derstanduratlu.u�e.,ruuslGiejurallelrar6csirrcur�rdJ'runr � - -• fhlroppficatiwr. I,Lcreby;gjsc coniciit to[lic AUU�orizcct 3tcpreswtattrc of IIlC Dxvic C dnty Itc ItL c��ar u�cnt to cnicr upon�bo�•c dcsvibcd ptuperty lucated iu Daric County anJ uirucd by j`f'��-��-����J��p � lu cunducc:ttl lesting proccdures as neccssnry to�cicrmiac fue stle suitabilit}�. DATL:3�� 5ICNATUIi�i / TI�TLS AItEA MAX IIL�VSLD TOR AYtAWING YOUR SITL�PL,4N(Inclucic a1i oI thc fnllo�vtug:TxfsLlvg gi�d prdpused propertylincsandctunensions,struetures,sct�acks, andscpticlocations). ,-,e� � . : 5i(c12e��isltCliar{;c Aatc(s): � . • • C71cutNollAcallunpata: , .I�iS: _ � •. . �6'nCn'� ' • AccountPto.��� � �p p��dc�d nn6m mun� �-- NtJ`�-'� L�(o "ZZ i 02/04/2005 14:53 3369405955 ALLYSON SAWTE�LE PAGE 01 , • ,�, , t f� d x _ .. � {r. +_ l � � � ,� � / V j��? � � ,_ � , �� � --�-?S /�� � ! �� 1 �s � �- �fs� � �o � , �� ��y��� , . _ - � �f� D ����� s�-3 , , - ,� �� � rt� � z� � . , ., � � �L-�G 3 , a z � � � � � � � � � . . � D � � ' CA?ION 1=01i 517L• CVALUAI'!ON/lh1PIiUVihJ1•NI'I'L•tthl!'I'&A'1'C � '�V�� �. . Davte Counfy Nealfh Department � v ,Environ�rrenta/Health Section � —�� � �HEA13� P.O. Dox 8�a/210 Ho��iLal S�reeL- ��N��pUN� 23ock�ville, NC 2702a (33G)751-Q7G0 . ' ' --_..____. .... � ***ItSPORTANT*** TIiIS I�PPLICATION CANNOT 13L PROCLSSLD U2dLLS5 ALL 'PlIL 1:�QUIiiLll INFORMATI02�i IS PROVID�D. Reror to L-ho INrOItMATION IIULL�TIN tor in:,L�:ucL-iou:►. . —...._............. ... 1. .Namc to be Dilled tAJ � 1 1 1�'tl�l �� t �Lr�.I l �)�` ConL•act Pcrson �_ ���.. ._... . ' Q <. �`� /� �/_ Q� 2•failing Addre�c 0 � � lIanc I�lionc "1 v _��.�!��V..__._. ... City/Statc/ZIP �[�UQ�C�. . /Vl�� �� Uuainca� Ylwria�. O � �,J l� `��—_— .._...._.. ...._.... 2. Namo on Pezmit/ATC it DiL=crent than 1lbovc � r _,..__...._. ...... . Mailing nddro3s City/SCatn/'Lip 3. Application For: �Site Evaluation � ❑ ImprovemenL Pezzni�/ATC � ❑ 17oLli ,', s. 4. spctem to service: �Hou�e ❑ 23ob,ile Home � Du�ine�:� ❑ InclusL-iy ❑ OL-l�cl �___ ___ ti. 5. Type aystem requeated:�onvontional ❑ conventional modiPicd ❑ innovaCivc G. If Residence: !E People I� }3edroom� II I3aL•h•roouu; !� . �_ �._.� .:.�.._� • �ahwaaher ❑Garbaga Dispo�al Washing Machino ❑IIa�ement/1�1uu1�in1 ❑La�emenL•/P7o l�lu�i�in� ` 7. Ii Duainen:,/Zndu�L-iy /OL-hcr: veriLy typc 1! Peopla IF'Sinl;a �, ------- # Commodca 11 Showers �F Urinaln If I9aL'cr Coolor� IF FOODSERVIC�: �� SeaLa �B�imated Water U:.age (gallan� per day) !__�__i_,' � e. Typc of water �upply:�County/City ❑ Well ❑ C011u11u11iL-]r , , 9. Do you anticipate additiona or CX�7A11S10115 Ur�11C f:ll'1j1Iy tI11S S)'S1C1111S lA�l'll(1L`(1 lU SL`1'1'C�� � ��l'S nt� !f}'cs,titi•liat typc? • . , . ***IAIPORTAN:I�`**CL1Ll�TS�)lUST COAIl'LGTL••rxL lu:�ufxcv i�itoi�Lii'1'1'1NI�OI�B�Ir1'1'lON Kls(?UIsS'l'lsll � I3GLOIV. I3itl�cr a PLA7'orSIT�PLAN dIUST IlCSU13�1fI7773D by thc clicut tii•ilh 7'1IIS A!'P1.ICA7'101`!. _ 1'roper(��Dimcusions: � I�X �`� l� 1�� X 23� 11'1Z1TL lllKLCI'lU�yS(1'rutu ll�lucics��illc) fu PItUI'l;lt'1'1': _ �:►a orr,«i�lrr: �� 5 �� ���� ��c� � ��(� �s-F '��,x'�-� l�sd ` �'ropertyAddress: �o��N����� � , �Sa 5 -4- ►5� c,�yiz;P �cl.�l�� 2`7bb� . br� � la, � " � - IClil�SUli(I1YlS1011 rl'OYl(IC lAIUl•mafio�i,as fullo�vs: � K� �+ Y1 t�! C``�'�UI(� , Naiiic: ' � t + Scclio�i: Blocl:: Lot: Datc liomc corucc•s II:ibbcd: �� � Tliis is ta ccrtify tliat thc iufot'l111t1011 I)1•ovidcd is corrccE to thc bcst ofiuy luiotivlcdbc. 1 Ull(IL`1'SI1i3(1 Ill.�l:iiiy peri�iil(s) issucd licrcaftcr are subjcct to suspcusion or rcvocatioii,if ttic sitc plans or iutciidcQ usc cli:iiibc,ui•if llic iii!'oi•iu:�(iuii subuiittcd iu this applicatiou is falsiIIccl or chanbcd. !,also,ruirlcrslai�rl[Irat I�uu rc��/�u�rsiLlc ja•«ll cJrrr�b�cs iircrrr•1•c�r!fi•u�l� l/!is upplicu�iu�r. I,licrcb�•,biti•c conscut (o tlic Aulhorizcd Rcprescutativc oP clic 1)ati�ic Cuuiifl'llcaltli llcp:u•(�i�cu( co ciitcl•upoii aboti•c dcscribccl pr�pc�•ty locatcd in llavic County and o���iicd b�� lu ca�duct all tesling proccdures as iicccssary to dcici•iiiiiic tlic silc suitabililJ�. • � DAT'L_�, �z.� �'t/ SIGNATUI2I; c TI�IS AIZEA MAY I3�USLD I+OR DRA.WAVG YOUR SIT.�PLAN(Iiicludc nl!uf llic L'ullotivitib: Lxisliiib stiicl p►•op�scd . property lincs and dimcusious, structures, sctb�clts, �nd scptic locations). f �� Q � � Sitc ltc��isil Cliar�;c � � �� -�. fi-�� "� S}�-� ��., ll:itc(s): �_ —1 �.� F� � �����r licut lYolircatioti Datc: � � dEG� , f' ' . . _ ,�?�,��� �o�---P���� �IIS: ` � �"t�' . .o� Sign givcn � ��o.�f-y Kr Accouut No. ��� �' .�' ' ' _ ,� _✓� `�-a� � Q �b Rcti�iscd DCIID(05/0z_ • � � +� � ' � . � � . . � • ,� w � DAVIE COUNTY HEALTH DEPARTMENT � • •� ' �• '" Environmental Health Section � Soil/Site Evaluation �� APPLICANT INFORMATION - . PROPERTY INFORMATION ! Account #: 990003274 �' Tax PIN/EH#: 5861-48-6550 Billed To: W. Martin Kittrell Subdivision Info: Reference Name: " Location/Address: King Arthur Lane-2Z006 Proposed Facility: Residence Property Size: see map Date Evaluated: ���1�5' �Water Supply: On-Site Well Community Public � Evaluation By: Auger Boring ✓ Pit � Cut ' FACTORS 1 2 3 4 5 6- ' 7 ' Landsca e osition L Slo e% � 3 HORIZON I DEPTH D� p�1 � - Texture rou � �i . Consistence � Structure C ` .Mineralo � HORIZON II DEPTH 2- 0� ' � Texture rou ' %� � Consistence ' ��j � � ' Structure , ' Mineralo —1t � _ HORIZON III DEPTH — Texture rou �t � � Consistence ; Swcture . � � Mineralo � HORIZON IV DEPTH � � < Texture rou ' � : Consistence � Structure ' Mineralo SOIL WETNESS , , RESTRICTIVE HORIZON SAPROLITE ' . CLASSIFICATION � LONG-TERM ACCEPTANCE RATE p. � SITE CLASSIFICATION: � EVALUATION BY: � LONG-TERM ACCEPTANCE RATE: �•3 '"d•�� � , OTHER(S)PRESENT: REMARKS: H'rT I _ � 2CI'fi ��� '-t� �`-�%��'�Q�..1�� K�s y1/�, - LEGEND ' , � �t,,r�t7��a� �}'�7�"- Landscape Position • R-Ridge S-Shoulder L'-Linear slope FS-Foot slope N-Nose slope • CC-Concave slope CV-Convex slope T-Terrace FP-Flood plain H-Head slope ' Texture , �. S-Sand LS-Loamy sand SL-Sandy loam L-Loam SI-Silt SICL-Silty clay loam SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay . C-Clay CONSISTENCE Moist VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm Wet NS-Non sticky SS-Slightly sticky S-Sticky V�-Very Sticky , NP-Non plastic SP-Slighdy plastic P-Plastic VP-Very plastic tructure ' � SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangulaz blocky PL-Platy PR-Prismatic Mineraloev 1:1,2:1,Mixed . � Notes Horizon depth-In inches Depth of fill-In inches Restrictive horizon-Thickness and inches from land surface ' Saprolite-S(suitable),U(unsuitable) ' Soil wetness-Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less Classi�cation-S(suitable),PS(provisionally suitable),U(unsuitable) LTAR-Long-term acceptance rate-gaUday/ft2 . 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' . ' � . . � . � . DAVIE COUNTY HEALTH DEPA�TMENT Environmental Health Section PO Box 848/210 Hospital Street Mocksville, NC 27028 Phone: (336)751-8760 /Fax: (336)751-8786 June 30, 2004 W. Martin Kittrell,7r. ; I83 Daye Lane ' ` Advance,NC 27006 ' Re: Site Evaluation- 0.88 Acre Tract/King .Arthur Ln Tax PIN#: 5861-48-6550 Dear Client(s): As requested, a representative from this office visited the above site June 30, 2004 � to perform a site evaluation. Based on the information provided on the Application for Site Evaluation and after the evaluation was completed,the site was found to be provisionally suitable for the installation of an on-site sewage disposal system. Before a representative of this of�ice will revisit the site to issue an Improvement PermitlAuthorization to Construct,the appropriate application must be completed and, submitted to this oi�ice. The location of the facility the system is to serve must be stak�d of� Additionally, please have the new parcel surveyed prior to making this request: If you have any questions, feel free to contact this office at 751-8760. Sincerel�, , � 7effG. Beauchamp,R.S. Environmental Health Section Enc(s) � � � ,;,,::� . . _ -, � �- � �-�:�� k T -,, �� 124 t ���.��� �4, ��:��� .�p ,; ; r ��` °�, ����� ���� � y . u$ � � , f� �. � w�' . � ai�e ���tF �'�' " g`� . . � � ti rt �q , . . > � , � _.�.. � ������ - � a , � F (1 73A) � ��� � �� .�� �� � , � , , � ;��� � � � � , � " ii�' z } � � � t�;� �' ,„'� ` �; �N � .. � � h� c�.�: . ;„'-� w � 7� " � � �- nQ . 1:9:� . ; . � .. � � � � �o �"'"' ��' �=` �CU� �� � ° � .�n �.�^ . � .,� �. 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